City of Titusville Gateway to Nature and Space

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Lindsay Simon
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City of Titusville Gateway to Nature and Space 555 SOUTH WASHINGTON AVENUE CUSTOMER SERVICE DIVISION TITUSVILLE, FLORIDA 32796-3584 (321)-383-5791 POST OFFICE BOX 2807 (32781-2807) Fax (321)-383-5848

1 City of Titusville Gateway to Nature and Space 555 SOUTH WASHINGTON AVENUE CUSTOMER SERVICE DIVISION TITUSVILLE, FLORIDA (321) POST OFFICE BOX 2807 ( ) Fax (321) Dear Prospective Customer, To apply for service with the City of Titusville, please visit our Customer Service Office located at 555 South Washington Avenue, Titusville, Florida Our office hours are 8:00 am to 5:00 pm, Monday through Friday, except Holidays. If you prefer to apply by fax, please complete the application for service and fax to (321) You may also mail in the application to the address listed above. Please make sure the following information is attached to the application when submitted: Signed Lease Agreement/ Letter of Authorization from Owner of Property (Tenant) Warranty Deed or Certificate of Title (Owner) Listing Agreement/Letter of Authorization from Owner of Property (Property Manager) Valid Copy of Driver s License/ Identification Card All new applicants for service require a deposit for water, sewer and garbage as available to the property. The deposit will be held on the account until either after 3 years of good credit or until the account is closed. We accept cash, personal checks, money orders, cashier checks, Visa and Master Card. Automatic payment is also provided online at the City of Titusville website. If you prefer to go paperless, please fill out the E-Bill Notification application. If you wish for same day service, we will need to receive the application and additional information before 1:00 pm, anything received after 1:00 pm will be the following business day. If you have any further questions, please contact our office at , Monday through Friday, 8:00 am to 5:00 pm. Sincerely, Customer Service City of Titusville Utility Billing 1

2 APPLICANT INFORMATION Last Name: First Name: Middle Name: Service Address: Home Number: Cell Phone Number: Emergency Number: Driver s License Number: Date of Birth: Expiration Date: ** PLEASE ATTACH COPY ** Mailing Address (If different from Service Address): City: State: Zip Code: Employer: Work Number: Last 4 of Social Security #: Address: For E-Bill Notification: ( ) E-Bill Only ( ) E-Bill & Printed Bill CO- APPLICANT INFORMATION The CO-Applicant information will not be listed on the account but will be listed in the notes as the 2 nd name on the property. Last Name: First Name: Middle Name: Driver s License Number: Date of Birth: Expiration Date: Contact Number: Work Number: Last 4 of Social Security #: Address: RESIDENTIAL Please Indicate if you are: ( ) Owner ( ) Tenant Additional Occupants: 1. Lease Date: 2. Purchase Date: 2

3 COMMERCIAL Please Indicate if you are: ( ) Owner ( ) Tenant Business Name: Phone: FEI# Sales Tax ID #: Company Name: PROPERTY MANAGEMENT Contact Number: Date of Inspection: ** Please allow three business days for processing of application ** Service Stop Date: Please note: Inspections are for five (5) Business Days only for $ If the service needs to be on longer than the three days, a full deposit will be required. The deposit is based on the services that are available to the property. ** A termination of service form must be signed by the applicant if the service is no longer needed. ** NEW CONSTRUCTION Please Indicate if you are: ( ) Owner ( ) Contractor Company Name: Contact Name: Contact Number: Please Note: In order for the meter to be installed, the permit board must be visible for our field technicians; if it is not then the meter will not be installed. Special Note: I understand that if the above service address is a construction site, that the City of Titusville will not be responsible for any damage, loss or theft of any portion of the water service including the water meter. All repairs and/or replacements are the responsibility of the applicant and must be completed prior to the certificate of occupancy. : Work Order Number: Meter Size: ( ) ¾ ( ) 1 ( ) 1 ½ ( ) 2 ( ) 3 Administrative Fee: Water Deposit: Initials: Sewer Deposit: ( ) $15.00 ( ) $30.00 Refuse Deposit: ( ) ( ) $34.00 ( ) ( ) $20.00 ( ) $40.00 ( ) $60.00 Irrigation Deposit ( ) $20.00 ( ) $40.00 ( ) $60.00 ( ) $30.00 ( ) $60.00 ( ) $90.00 Total Deposit Amount Due: 3

4 Dumpster Deposit: Dumpster Size: Cart Verification: Recycle: ( ) Yes ( ) No Refuse: ( ) Yes ( ) No Past Due : Past Due Amount: Total Amount Due: Please read and sign below: CUSTOMER INFORMATION: I, the undersigned, understand that I am responsible for all charges for above services requested, and will continue to be responsible for same until such time as I request written termination of service. I understand that non-payment will result in termination of utility services. I understand that when transferring my service to another location in the city limits, I must pay all outstanding charges and a new deposit if applicable. I also understand that any deposit paid will be applied to the account on the final bill and any resulting credit will be refunded in 4-6 weeks from the date of termination. I am also responsible for making sure that all faucets are turned off before the service can be established. The city is not liable for damages caused by water faucets or outlets turned on. I also understand that if I do not plan to be present at the time that the water service is connected and a tag is hung that I will need to make arrangements to be present when a field technician schedules a service visit. If a third trip is made, then a $15.00 service charge will be applied to the account. You are signing below that you have received a copy of the City of Titusville Utility Ordinance and you have also read and understood the information above. Print Name of Responsible Party: Date: Signature of Responsible Party: Time: 4

5 OFFICE STAFF CHECLIST ( ) Brevard County Property Appraiser Verification of Owner of Property Verify Use Code ( ) Lease Agreements/ Warranty Deed Verify that ALL applicants have signed the documents provided Verify Service Address is correct Verify Previous Owner Debt is paid with Lien Department ( ) Application for Service Verify Application is filled out and completed Copy of Driver s license is attached ( ) Work Orders Verify correct work orders have been issued (turn on, turn off, initial/final read, new cart) Dummy Meter- issued meter reset work order ( ) Customer Account Miscellaneous Notes (if needed) Administrative Fee/ Deposit s Paid Update Owner information (Mailing Address) Verify Customer Type 5

Please make sure the following information is on the application or attached to the application when submitted:

Please make sure the following information is on the application or attached to the application when submitted: Dear Prospective Customer: To apply for service with the City of Ocala Utility Services, you may visit our Customer Service Office, fax, email, or mail the attached service application. Service applications